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Prior Authorization Coordinator START 2/28

4 months ago

Northridge, California, United States Aston Carter Full time
  • Understand and execute the principles of Prior Authorization to facilitate the right care at the right time in the right setting.
  • Perform all assistant and coordinator job functions.
  • Able to solve complex prior authorization questions and issues.
  • Effectively handle all incoming provider calls including the most challenging provider offices.
  • Identified trends with provider offices and interfaces with those provider offices.
  • Request Network Management training or on site visit to provider offices needing reinforcement.
  • Identify issues that need to be escalated to a lead or supervisor.
  • Identify opportunities for improvement and make recommendations for change.
  • Process requests from Access Express that are pended or reprocess approved or denied auths and package properly for review and resolution.
  • Check eligibility and benefits on all items requiring a benefit check such as DME and home health authorizations prior to forwarding on request to prior authorization nurse or medical director for approval.
  • Capture any leakage and provide feedback to the leadership team for additional training.
  • Maintain turnaround time compliance in all aspects of the Prior Authorization process.
  • Work in collaboration with the department Prior Auth Assistants, Specialists, Team Leads,
  • Supervisor, Managers and Regional Medical Directors and Network Managers to ensure a level of referral processing that meets or exceeds the organization's expectation.
  • Recognize when an error has been made and immediately report it to the appropriate supervisor or manager.
About Aston Carter:

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At Aston Carter, we're dedicated to expanding career opportunities for the skilled professionals who power our business. Our success is driven by the talented, motivated people who join our team across a range of positions – from recruiting, sales and delivery to corporate roles. As part of our team, employees have the opportunity for long-term career success, where hard work is rewarded and the potential for growth is limitless.

Established in 1997, Aston Carter is a leading staffing and consulting firm, providing high-caliber talent and premium services to more than 7,000 companies across North America. Spanning four continents and more than 200 offices, we extend our clients' capabilities by seeking solvers and delivering solutions to address today's workforce challenges. For organizations looking for innovative solutions shaped by critical-thinking professionals, visit Aston Carter is a company within Allegis Group, a global leader in talent solutions.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please call or email for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.